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Hospitals Need an Extra Dose of Philanthropy
By Henry Goldstein
Reprinted with permission from The Chronicle of Philanthropy, February 1999

Recently I spent three days in a place I'll call Millennium Medical Center, one of New York City's great teaching institutions. I came in horizontally and left vertically -- the happy result of a positive experience with every member of the staff, save the triage nurse in the E.R.

While the medicine at Millennium was stunningly up to date, the philanthropic effort was woefully out of date. Having served health-care clients for almost 30 years as a fundraising and public-relations consultant, it was clear to me that someone wasn't paying attention.

No one asked me for a gift. In fact, no one bothered to ask what kind of experience I had at Millennium. No discharge packet, no survey -- just a friendly nurse who cut off my plastic bracelet and wished me well.

The reason no one asked for a contribution is simple, and it has nothing to do with patient confidentiality or fear of giving me offense. Though Millennium and other hospitals will deny it, philanthropy is no longer a central priority. Indeed, institutional survival in the nation's cutthroat health-care market involves business acumen a lot more than it does charity. And without leadership from the board on down, the custom of routinely asking everyone to give naturally atrophies.

In most hospitals, the fundraising process has been cut away from the body proper (so to speak) and is usually lodged in a foundation, or some other separately incorporated entity whose task it is to comb the donor wool. Some foundations do well, but others don't even come close to covering the amount of free care their parent institutions render in any given year.

Whether that is true of Millennium, I don't know. What I do know is that Millennium, like teaching hospitals everywhere, is locked in the jaws of a berserk system in which control has largely passed from the doctors and the hospital administration to insurance companies. The process is widely known as managed care -- a clear misnomer. Cost is managed, care is rationed. If you're an insured, basically healthy, but momentarily sick person, the system works fine. If not, you're in big trouble, and philanthropy will make little or no difference to you.

Millennium's trustees -- like the boards of other large health-care systems throughout the country -- are focused on financial matters, takeovers, mergers, real-estate acquisition, for-profit business opportunities, and the like. And that's what they must do to survive.


Henry Goldstein, president of the Oram Group, a fund-raising consulting company in New York, is a regular contributor to these pages. Click here to send an email.